Alveolar Corticotomy-Assisted Orthodontic Closure of a Long-Standing Mandibular First Molar Edentulous Space: A Case Report

Premature loss of a permanent first molar can lead to functional impairment, food impaction, occlusal instability, and compromised masticatory efficiency. While implant-supported rehabilitation is frequently used to restore missing posterior teeth, orthodontic space closure may provide a conservative alternative in selected patients. This case report describes the management of a 22-year-old healthy female patient who presented with a three-year history of an untreated mandibular right first molar edentulous space following the extraction of tooth #30 at the age of 19. The patient reported recurrent food accumulation within the edentulous area, irritation of the surrounding soft tissues, and difficulty chewing comfortably on the affected side. A multidisciplinary treatment plan was developed to close the edentulous space through mesial movement of teeth #31 and #32. To facilitate orthodontic tooth movement, alveolar corticotomy was performed under local anesthesia. Multiple cortical perforations were created within the edentulous ridge, followed by placement of a collagen membrane and stabilization with 4-0 nylon sutures. Orthodontic treatment was continued after healing to progressively advance the posterior teeth into the edentulous area. Substantial space closure was achieved after approximately eight months of active orthodontic movement, followed by additional treatment for alignment and occlusal refinement. Clinical and radiographic evaluation demonstrated favorable healing, successful reduction of the edentulous space, improved posterior occlusal support, elimination of food impaction, and enhanced masticatory function. The patient reported high satisfaction with both the functional and esthetic outcomes. This case highlights the potential of alveolar corticotomy-assisted orthodontics as a conservative treatment approach for managing long-standing posterior edentulous spaces and demonstrates its ability to facilitate challenging tooth movement while avoiding implant rehabilitation in appropriately selected patients.